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N928 - Basic Principles > Monitored Anesthesia Care (MAC) > Flashcards

Monitored Anesthesia Care (MAC) Flashcards

1
Q

difference between MAC & general anesthesia

A

MAC - patient can maintain own airway with reflexes

general anesthesia- patient is unresponsive and unable to protect own airway

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2
Q

4 levels of continuum of sedation depth

A
  1. minimal sedation (Anxiolysis)
  2. moderate sedation (Conscious sedation)
  3. Deep sedation
  4. General anesthesia
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3
Q

To perform MAC, considerations are:

A
  1. pt must be able to cooperate
  2. pt must be able to remain motionless
  3. pt must adhere to pre-op NPO guidelines
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4
Q

Loss of ____ reflex indicates loss of ____

A

eyelash, protective airway reflexes

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5
Q

Required MAC monitors

A
  • BP
  • ETCO2
  • EKG
  • Pulse Ox
  • assessment of ventilation adequacy
  • presence of qualified anesthesia provider
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6
Q

Additional MAC monitors (4)

A
  • precordial stethoscope
  • temperature monitoring
  • capnography
  • consciousness monitor (BIS)
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7
Q

oxygenation devices in MAC

A 
nasal cannula
face mask
oral airway
nasal airway
chin lift or jaw thrust
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8
Q

assessment of oxygenation/ventilation

A
  • chest excursion
  • skin color
  • nasal/oral airway movement
  • condensation in face mask
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9
Q

Versed administered for

A

anxiolysis & amnesia

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10
Q

Fentanyl or opioid used for

A

analgesia

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11
Q

Propofol used in MAC for

A

sleep

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12
Q

Local anesthetics in MAC used for

A

infiltration / field block

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13
Q

medication dosages highly variable due to:

A
  1. surgical stimulus
  2. patient medical history
  3. surgeon experience
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14
Q

Versed synergistic with __

A

opioids

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15
Q

Opioids used in MAC

A

alfentanil
fentanyl
morphine
remifentanil

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16
Q

opioids may cause
1 resp
1 cv

A

respiratory depression

bradycardia

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17
Q

3 targets of opioids in pain management

A
  1. inadequate local anesthetic
  2. uncomfortable position
  3. tourniquet use
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18
Q

superior drug for MAC cases ___

A

propofol

19
Q

propofol good for ____ in MAC

A

sedative-hypnotic properties

20
Q

positives of propofol

A
  • short acting
  • rapid onset
  • short duration
  • decreased N/V
21
Q

Propofol bolus technique during MAC

A

10-20mg PRN

22
Q

propofol continuous infusion during MAC

A

25-75mcg/kg/min

23
Q

additional medications used during MAC (4)

A
  • ketorolac
  • ketamine
  • clonidine
  • dexmedetomodine
24
Q

positioning during MAC

A

for level of sedation, consider:

  • ease of airway manipulation
  • ability to access & control airway
25
Q

Plan B during MAC

A

ALWAYS general anesthesia

26
Q

Why does MAC fail (4)

A
  1. inadequate LA
  2. painful position
  3. uncooperative patient
  4. paradoxical effects from sedation
27
Q

INAPPROPRIATE MAC cases

A
  • muscle relaxation required
  • difficult airway with limited access
  • Peds
  • psychiatric disorders
  • uncooperative patients
  • pt that refuses MAC
28
Q

during MAC, always prepare for:

A

*advanced airway management / general anesthesia

29
Q

have ___ at bedside

A

equipment for general anesthesia & airway adjuncts

  • medications
  • suction
  • oral/nasal airways, LMA, ETT, laryngoscope, blades/handles
30
Q

___ is the best monitor

A

vigilance

31
Q

greatest danger during MAC

A

lack of vigilance

32
Q

standards of care during MAC =

A

standards of care during general anesthesia

33
Q

4 effects of medications we want during MAC

A
  1. anxiolytic
  2. hypnotic
  3. analgesic
  4. amnestic
34
Q

PRIMARY objective during MAC

A

provide patient safety & comfort during procedures for which general anesthesia is not used

35
Q

MAC invokes ___ than general & provides ___ than general

A

less physiological disturbances

more rapid recovery

36
Q

in CONSCIOUS SEDATION, pt maintains (2)

A
  1. adequate cardiorespiratory function

2. ability to purposefully respond with verbal/tactile stimulation

37
Q

MAC anesthesia ____ than conscious sedation

A
  • potential for deeper sedation

- loss of protective reflexes or consciousness likely

38
Q

*MOST common cause of brain injury during MAC

A

**inadequate ventilation

39
Q

__ may quickly change depth of MAC

A

interpatient response variability to drugs

40
Q

MAC helps to (2)

A
  • relieve anxiety & apprehension

- prevent recall of unpleasant perioperative events

41
Q

Minimal Sedation

  1. responsiveness
  2. airway patency
  3. spontaneous ventilation
  4. cardiovascular function
A

“anxiolysis”

  1. normal response to verbal stimulation
  2. unaffected
  3. unaffected
  4. unaffected
42
Q

Moderate Sedation

  1. responsiveness
  2. airway patency
  3. spontaneous ventilation
  4. cardiovascular function
A

“conscious sedation”

  1. purposeful response to verbal or tactile stimulation
  2. no intervention required
  3. adequate
  4. usually maintained
43
Q

Deep Sedation

  1. responsiveness
  2. airway patency
  3. spontaneous ventilation
  4. cardiovascular function
A
  1. purposeful response following repeated or painful stimulation
  2. intervention may be required
  3. may be inadequate
  4. usually maintained
44
Q

General Anesthesia

  1. responsiveness
  2. airway patency
  3. spontaneous ventilation
  4. cardiovascular function
A
  1. unarousable, even with painful stimulus
  2. intervention often required
  3. frequently inadequate
  4. may be impaired

N928 - Basic Principles (22 decks)

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